ACOG

Turning a page for Maternity Care

I am pleasantly surprised that we may be FINALLY turning a page in the her-story of medicalized maternity care. While most fields of medicine base their practices on the latest and best science, maternity care has been in the dark ages, leaving a huge gap between what science knows and what we practice. This gap puts MotherBabies at risk, creates birth trauma and ultimately has added to the growing FEAR of childbirth that many expectant parents and even some providers feel.

From doulas to movement, the group outlined ways to help curb intervention in low-risk moms.

The American College of Obstetricians and Gynecologists has released new guidelines encouraging OB-GYNs and other birth practitioners to re-examine the necessity of various interventions that may not necessarily benefit low-risk moms.

The new committee opinion does not signal a dramatic shift in best practices for managing uncomplicated labors, but it is a clear acknowledgement from ACOG that technological interventions can often times interfere with a natural process rather than help it along.

“This committee opinion is the first one, to my knowledge, that specifically addresses low-risk patients,” author Dr. Jeffrey L. Ecker, chief of the Obstetrics and Gynecology department at Massachusetts General Hospital told The Huffington Post. “It says, very clearly, that there are some times when watchful waiting is appropriate. Just because we have the technology, doesn’t mean it has to be used in every patient.”

Many doctors and hospitals already embrace measures to limit intervention when appropriate, he said. But for others, this will likely shift the standard care.

More and more research has said there are benefits to keeping the umbilical cord attached for several minutes after childbirth ― a practice known as “delayed cord clamping.” But the American College of Obstetricians and Gynecologists has held off from endorsing the practice, saying there was insufficient evidence to support it universally.

This week ACOG issued new guidelines changing its stance. In the first policy opinion on the topic issued since 2012, the group now recommends that doctors and midwives hold off on clamping all healthy newborns’ cords for at least 30 to 60 seconds.

“While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both [all] infants,” Dr. Maria Mascola, lead author of the new ACOG opinion, wrote in a press release. “And, in most cases, this does not interfere with early care, including drying and stimulating for the first breath and immediate skin-to-skin contact.”

If you look at scientific literature, you find over and over again that many interventions increase risk to mother and child instead of decreasing it.

When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. What they don’t envision is the omnivorous, pants-wearing science geek standing before them.

Indeed, they become downright confused when I go on to explain that there was really only one reason why my mate — an academic internist — and I decided to ditch our obstetrician and move to a midwife: Our midwife could be trusted to be scientific, whereas our obstetrician could not.

(click link at the top to read the rest of the article on TheAtlantic.com)

10 procedures to think twice about during your pregnancy

Despite a healthcare system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations. Infants in this country are more than twice as likely to die before their first birthday as those in Japan and Finland. And America now ranks behind 59 other countries in preventing mothers from dying during childbirth and is one of only eight countries in the world, along with Afghanistan and El Salvador, whose maternal mortality rate is rising.

Why? Partly because mothers in the U.S. tend to be less healthy than in the past, “which contributes to a higher-risk pregnancy,” says Diane Ashton, M.D., deputy medical director of the March of Dimes.

But another key reason may be that medical expediency appears to be taking a priority over the best outcomes. The U.S. healthcare system has developed into a labor-and-delivery machine, often operating according to its own timetable rather than the less predictable schedule of mothers and babies. Keeping things chugging along are technological interventions that can be lifesaving in some situations but also interfere with healthy, natural processes and increase risk when used inappropriately.

“…physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities.” — ACOG Committee Opinion, Physical Activity and Exercise in Pregnancy and the Postpartum Period